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Newborn Mortality Rates Are Not Color Blind

Op-Med is a collection of original articles contributed by Doximity members.

Victor Ekuta is a 2020–2021 Doximity Research Review Fellow. Nothing in this article is intended nor implied to constitute professional medical advice or endorsement. The views expressed in this article are those of the author and do not necessarily reflect the views/position of Doximity. 

For a host of social, economic, and medical reasons, Black newborns are twice as likely to die in their first year than white infants. A recent paper may shed additional light on this phenomenon. In the study, Greenwood et al., examined the records of 1.8 million Florida hospital births between 1992 and 2015 and uncovered a sobering statistic. Though Black newborns are three times as likely to die as white newborns, when the doctor of record was also Black, their mortality rate decreased by half. By contrast, the race of the doctor caring for white babies did not significantly affect the likelihood of the newborns’ survival. Most striking, the effects were strongest for complicated births, and in hospitals that delivered more Black newborns. The finding is an association, not cause and effect, but the study nonetheless raises a fundamental question: Why?

The reasons are likely complex and multifactorial, but rooted in systemic racism. For one, Black Americans make up 13% of the U.S. population but only 5% of the physician workforce, an underrepresentation that can contribute to a disconnect and lack of trust between physicians and Black patients. Indeed, experimental evidence has highlighted how physician-patient racial concordance can foster improved communication and trust. 

Fully understanding the reasons for the Black-white infant mortality gap will not be easy, and will undoubtedly require more research. That said, Greenwood et al.’s study underscores the importance of ensuring that all babies receive the best care from all doctors, regardless of race. If physician race is a proxy for physician practice behavior, then the study makes clear that diversifying the physician workforce and investing in strategies that reduce physician bias might be just the prescription we need to remedy this long-standing problem. Doctor’s orders.

Victor Ekuta is an MD candidate at UC San Diego School of Medicine. He has previously served as a TEDMED Research Scholar and a Doris Duke Clinical Research Fellow, among many others. In the future, he plans to specialize in academic neurology as a physician-scientist-advocate, employing novel approaches to treat human brain disease, combat health disparities, and boost diversity in STEM.

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